Provider Demographics
NPI:1598302655
Name:GOLDEN VALLEY HEALTH CENTER
Entity Type:Organization
Organization Name:GOLDEN VALLEY HEALTH CENTER
Other - Org Name:GOLDEN VALLEY HEALTH CENTERS-CENTRAL VALLEY PACE MODESTO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-724-6000
Mailing Address - Street 1:2401 E ORANGEBURG AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3396
Mailing Address - Country:US
Mailing Address - Phone:209-724-6000
Mailing Address - Fax:
Practice Address - Street 1:2401 E ORANGEBURG AVE STE 330
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3396
Practice Address - Country:US
Practice Address - Phone:209-724-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-06
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)